Return to work after critical illness: a systematic review and meta-analysis
Return to work after critical illness: a systematic review and meta-analysis
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DOI：
10.1136/thoraxjnl-2019-213803
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发表时间：
2020-01-01
期刊：
影响因子：
10
通讯作者：
Hopkins, Ramona O.
中科院分区：
文献类型：
--
作者：
Kamdar, Biren B.;Suri, Rajat;Hopkins, Ramona O.
背景危重疾病的幸存者在住院后往往会经历糟糕的结局，包括延迟返回工作岗位，这会带来重大的经济后果。目的对危重病患者重返工作岗位进行系统回顾和荟萃分析。方法计算机检索PubMed、Embase、QicINFO、CINAHL、Cochrane图书馆1970~2018年2月的数据库。数据被提取，一式两份，并使用随机效应Meta回归获得合并估计。结果52项研究评估了10015名危重病幸存者重返工作岗位，平均随访时间为12个月(6.25-38.5)个月。随访1~3个月、12个月和42~60个月，合并复工率(95%CI)分别为36%(23%~49%)、60%(50%~69%)和68%(51%~85%)(tau(2)=0.55，I-2=87%，p=0.03)。根据诊断(急性呼吸窘迫综合征(ARDS)与非ARDS)或地区(欧洲、北美与澳大利亚/新西兰)，没有观察到显著差异，但当比较就业评估模式(面对面与电话与邮件)时，观察到显著差异。重返工作岗位后，20%-36%的幸存者经历了失业，17%-66%的人换了职业，5%-84%的人就业状况恶化(例如，工作时间减少)。延迟返回工作岗位的潜在风险因素包括先前存在的合并症和医院后的损害(例如，精神健康)。结论约三分之二、五分之二和三分之一的重症监护病房幸存者在出院后3个月、12个月和60个月内失业。重返工作岗位的幸存者往往会面临失业、换职业或更糟糕的就业状况。应设计和评估干预措施，以减轻这一常见而重要的问题对危重疾病幸存者的负担。
Background Survivors of critical illness often experience poor outcomes after hospitalisation, including delayed return to work, which carries substantial economic consequences. Objective To conduct a systematic review and meta-analysis of return to work after critical illness. Methods We searched PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from 1970 to February 2018. Data were extracted, in duplicate, and random-effects meta-regression used to obtain pooled estimates. Results Fifty-two studies evaluated return to work in 10 015 previously employed survivors of critical illness, over a median (IQR) follow-up of 12 (6.25-38.5) months. By 1-3, 12 and 42-60 months' follow-up, pooled return to work prevalence (95% CI) was 36% (23% to 49%), 60% (50% to 69%) and 68% (51% to 85%), respectively (tau(2)=0.55, I-2=87%, p=0.03). No significant difference was observed based on diagnosis (acute respiratory distress syndrome (ARDS) vs non-ARDS) or region (Europe vs North America vs Australia/New Zealand), but was observed when comparing mode of employment evaluation (in-person vs telephone vs mail). Following return to work, 20%-36% of survivors experienced job loss, 17%-66% occupation change and 5%-84% worsening employment status (eg, fewer work hours). Potential risk factors for delayed return to work include pre-existing comorbidities and post-hospital impairments (eg, mental health). Conclusion Approximately two-thirds, two-fifths and one-third of previously employed intensive care unit survivors are jobless up to 3, 12 and 60 months following hospital discharge. Survivors returning to work often experience job loss, occupation change or worse employment status. Interventions should be designed and evaluated to reduce the burden of this common and important problem for survivors of critical illness.